| NPI | 1467940163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2025011424) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: KS 04-51207) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2025-12-10 |